Why Health Equity Matters And How Data And Incentives Can Help Us Achieve It

Sara Ratner, Senior Vice President of Government Markets and Strategic Initiatives at Icario

In recent months, health equity has persisted as a central concern for health care leaders, regulators, healthcare plans, providers and patients. As the global pandemic and social justice movements have exposed and highlighted unequal access to care—as well as the biases embedded in the healthcare system—achieving an equitable system has never felt so crucial or possible. Still, recent telehealth expansion and utilization have only exacerbated and crystallized digital disparities.

So what can leaders in the health industry do about it? This is a compounded ecosystem and structural issue without any single clear solution. This is why, as a starting point, it is important to leverage data and financial incentives if we want to uncover strategies for improving both access and outcomes.

What is health equity?

Health equity simply means achieving a system in which every person has an equal opportunity to secure the best possible outcome, regardless of their socioeconomic or demographic status. Achieving health equity requires addressing social determinants of health (SDoH), including barriers such as food insecurity and housing instability, which can negatively impact a person’s health.

How can data lead the way to healthcare solutions?

In recent years, health plans have engineered systems to collect member health data which, combined with third-party non-healthcare consumer data, can create a 360-degree perspective of social stratification and the associated challenges. With this knowledge, plans can more easily understand the SDoH obstacles their members face in accessing care.

For example, the FCC’s broadband map coupled with member profiles can afford insight into how well members can access telehealth and other digital care. In addition, this geographic mapping further contextualizes a members’ economic status, food access, housing conditions and more to help anticipate and proactively deploy interventions addressing health conditions.

From Medicaid eligibility to census data, there are a number of insightful data points that create a more comprehensive narrative about a member’s access to care, barriers they may face and how the system can better support their needs. These factors can include:

•Geographic location, housing status (including whether a person rents versus owns a home) and average utility spend

•Transportation accessibility and patterns of use

•The nearest grocery store or healthcare provider

•The likelihood the person works full- or part-time (and whether they can access healthcare without taking time off work)

•Cultural insights into healthcare engagement propensity as well as access to healthcare resources

•The use of food assistance programs (taking into account that support subsidies run out at the end of each month, causing resource strain at that time)

How can financial incentives spur change in healthcare?

Coupling financial incentives with healthcare system performance can accelerate the creation of opportunities for systemic change. Consider the impact of the Affordable Care Act’s introduction of Star Ratings and its corresponding payment incentives on health plan performance. Star Rating measures, including quality of care, compliance and member satisfaction, can now afford bonus payments in top-performing plans. These payments are redistributed to members through reduced premiums and cost-sharing, as well as extra supplemental benefits which have engendered greater member satisfaction and higher ratings. These measures have created motivation for plans to optimize their performance in order to fully realize annual bonus payments.

Federal and state financial incentives can galvanize the healthcare systems’ health equity commitments. Here are ten factors that should be weighed while engineering these initiatives:

1. Utilizing Risk Models

We can continue to embed incentives into value-based care models to motivate provider data collection and proactive interventions for high-risk and underserved populations. Bonuses can be made available for reaching certain engagement and outcome targets.

2. Standardizing Data Elements

We can create a common set of core data elements and standards to establish industry-wide benchmarks for collecting and using SDoH data.

3. Incentivizing Member-Specific Interventions

We can incentivize partnerships with provider organizations to design tailored, personalized services for high-risk members, as opposed to conventional and uniform interventions.

4. Incentivizing Data Collection

We can offer incentives for Medicaid-managed care and Medicare Advantage plans to collect member data for a more discernible study of population stratification and stronger micro-segmentation strategies. These could originate with a pay-for-performance initiative, for example, or an independent Star rating system.

5. Making Risk Adjustments

We can implement coefficients with data elements tied to demographic or social information, such as race, ethnicity or gender.

6. Inclusion And Promotion Of FQHCs

We can designate bonus payments to Federally Qualified Health Centers (FQHCs) that perform interventions promoting health equity.

7. Addressing Language And Cultural Barriers

We can support and fund health plans and providers that offer translation and interpretation services, addressing language barriers as well as cultural differences.

8. Advancing The Usage Of Coding

We can enable better data collection of socioeconomic variables by incentivizing the use of SDoH Z codes to identify social risk factors and unmet needs.

9. Measuring And Highlighting Outcomes

We can provide funding to measure and publicly report on how health equity affects outcomes.

10. Boosting Infrastructure Support

We can create initiatives to motivate and support building the infrastructure needed to collect meaningful member data.

The Future Of Healthcare Equity

Now is an auspicious moment for the healthcare industry to redouble its commitment to health equity. Consider the incentive strategies in states like Oregon, Minnesota and Washington, which are promoting everything from data collection to equity performance. The Centers for Medicare & Medicaid Services (CMS) also recently made equitable care a central tenet of their latest strategic plan. In addition, a recent study from the Institute for Healthcare Improvement report as many as 58% of providers listed health equity as a top priority (compared to 25% in 2019).

In the words of Dr. Martin Luther King Jr: “Of all forms of inequality, injustice in healthcare is the most shocking and inhumane.” While this may be an enduring challenge, industry-wide progression toward health equity is sustainable through persistent investments and incentives. But collectively, it will require a widespread commitment to change from disparate healthcare leaders. To secure impartial and ubiquitous healthcare access, we all must play a role.


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